ORLANDO, Fla – Two studies presented at the National Kidney Foundation’s 2017 Spring Clinical Meetings showed the benefits of coordinated and integrated care.
Pilot intervention for kidney disease reduces costs and improves patient outcomes
A randomized controlled trial on Cigna customers with chronic kidney disease found that patients at risk for progression from stage four to five CKD fared better after intervention by a payer case management team. The study measured hospital admissions, emergency room visits, nephrologist visits, dialysis, fistula placement and total medical costs.
The study authors conducted a randomized controlled trial on 7,720 commercially insured Cigna customers with CKD between January 2012 and October 2012; there were 3,861 with intervention and 3,859 controls. After using an algorithm to identify patients at highest risk of progression from stage four to five, a payer case management team implemented an evidence-based assessment tool, provided education and follow-up, engaged the nephrologists and other providers, and conducted weekly rounds with the medical director for this group of patients. A follow-up study was conducted through July 2013.
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The study authors found that the intervention group had slightly fewer hospital admissions and slightly more nephrologist and emergency room visits, though these were not significant. As compared to controls, intervention patients were 12% more likely to have a fistula placement; and have a savings of $199 per member, per month, in medical costs.
The cost savings equated to 6% lower total medical costs in the intervention group, half of which came from improved in-network utilization, and the other half from reduced hospital costs.
The study findings support the value of care coordination between nephrologists, providers, and payer case managers in improving outcomes and reducing total medical costs among patients at risk for CKD progression from stage four to five.
Study finds specialized disease management program reduces costs and hospital stays for kidney patients
A study of commercially insured patients with stage four or five chronic kidney disease patients found that patients who have a specialized disease management program (DM) available to them have reduced medical costs, reduced inpatient hospital admissions, and better patient outcomes, compared to patients without the program.
Patients included in the study were commercially insured, at least 18 years old, and were identified as having Stage four or five CKD during January 1, 2013 – December 31, 2015. The study authors compared two populations: a group of 8,366 patients who had the DM program available to them and a group of , 20,720 who did not.
The availability of the program depended on the patient’s employer purchasing the program. This study included 29,086 unique patients: 8,366 were eligible for the DM program, 20,720 were not eligible for the program.
Patients who had access to the DM program had significantly lower monthly medical spending than patients who did not, $2,430 compared to $2,917. In addition, patients who had access to the DM program had significantly fewer monthly inpatient admissions than patients who did not have access to the program, 0.04 compared to 0.05. Patients who had access to the DM program also had a decreased risk of starting chronic dialysis compared to individuals who did not.